Provider Demographics
NPI:1366400558
Name:LOUIS, MICHELLE (DO)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:LOUIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8100 E 22ND ST N
Mailing Address - Street 2:BLDG 2200-2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2388
Mailing Address - Country:US
Mailing Address - Phone:316-440-8383
Mailing Address - Fax:316-440-8163
Practice Address - Street 1:8100 E 22ND ST N
Practice Address - Street 2:BLDG 2200-2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2388
Practice Address - Country:US
Practice Address - Phone:316-440-8383
Practice Address - Fax:316-440-8163
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0522869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE45962Medicare UPIN
KS104042Medicare ID - Type Unspecified